- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.65 / $176.38 / $231.24
| Facility | | $33.65 | $176.38 | $231.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.54 / $21.26 / $33.65
| Professional | | $17.54 | $21.26 | $33.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.72 / $23.37 / $73.25
| Facility | | $22.72 | $23.37 | $73.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.67 / $30.56 / $38.20
| Professional | | $16.67 | $30.56 | $38.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.58 / $30.57 / $119.60
| Facility | | $26.58 | $30.57 | $119.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.35 / $21.71 / $30.72
| Professional | | $20.35 | $21.71 | $30.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.16 / $15.71 / $15.95
| Professional | | $11.16 | $15.71 | $15.95 |